Every doctor has ugly secrets: the diseases they can’t confidently diagnose; the colleagues they struggle to work with; the new drugs they don’t know about yet. I have another one – I’m a dreadful immigration officer.
This didn’t use to stop me going about my business on the wards. The UK government’s recent proposal that Emergency departments charge migrants for emergency medical treatment is going to make it much more difficult.
Earl Howe (Under-Secretary of State for Health, surprisingly, despite a career in banking – not healthcare) tells us we need a “system… fair to the hardworking British taxpayers who fund it”. Absolutely right. But arguments about individual immigration rights and treatment eligibility need to stay out of the Emergency department.
Anyone who says otherwise needs a medical check-up (if they’re eligible). This ill-thought out and dangerous policy is going to make life more hazardous for staff and patients – regardless of their nationality.
The proposal is unworkable, unpalatable, and it makes for bad medicine.
Our Emergency departments already struggle to see patients withoutintolerable delays. There’s absolutely no way that frontline staff can request a credit check on each new patient without it taking time away from their other work.
Ministers are confident that clinicians will somehow save them from having to make explicit what they’re actually proposing. They’re suggesting that the NHS, which spent over £12 billion failing to introduce a computerised health record, take on the roles of passport control, financial advisors and bailiffs, applying those roles fairly and transparently across different hospitals, whilst still trying to diagnose and treat our “hardworking English taxpayers” within four hours of their arrival.
Some would call this ambitious. Others would be less polite. Especially when the real immigration people aren’t doing so well.
The Department of Health says “life saving treatment” will still be provided for all, free of charge. But even if we did establish at the front desk that this was all a patient was entitled to, what does that actuallymean in practice?
It’s a wonderfully soothing term: free treatment only for the most needy. The reality is different. Most patients who need inpatient treatment aren’t critically unwell. But failing to provide timely treatment when their illness is manageable makes it more likely that when they do return, it really will be an emergency. Emergencies are more expensive to treat, but the NHS will cover them for free.
Our government is openly proposing to send home from A&E patients with treatable conditions who can’t pay up. ‘Sending them home’ means they’ll go back to their hostel in Brentford, of course, not their family doctor in Bangalore. So they’ll end up returning to the same A&E for more expensive treatment than they needed the first time round.
Then, because they’re only entitled to “life saving” care, they’ll be discharged too early, without the medication that will help them recover, to begin the cycle again. If this saves anyone money, sign me up for a Ponzi scheme.
The sad truth about hospitals is that they don’t deal with groups of people, they deal with individual patients. And whilst it may be politically expedient to limit care for Immigrants (caricatured as populations, parasites, threats), immigrants (individuals, real people) tend to be far more deserving.
Most of the patients receiving care to which they’re not fully entitled will be confused, elderly people who need help from a system that no longer deems them eligible for it. Like this man. Whilst they may approve of healthcare restrictions in theory, hardworking British taxpayers will find it entirely unpalatable to see individual patients chased down for the crippling costs of their healthcare.
We will balk at it. We are the most charitable developed nation in the world. We will not sit comfortably when the elderly man in the Resuscitation bay opposite ours is told to leave because he’s now “well enough”, knowing that the decision would have been different if he hadn’t reached his credit limit.
It makes for bad medicine
To my eternal shame (and I truly mean that: I will never do this again), I once tried to combine the roles of doctor and immigration officer. My patient, Aziz*, had already been treated in his own country for a serious infection arising from a large tumour. He then travelled to London hoping to find a private surgeon who would treat him. Aziz’s condition worsened, and he was brought straight from the airport to my hospital.
On the ward, I faced daily dilemmas. Aziz was stable, but still required ongoing care for a recurrence of his infection. When did this stop being an emergency? Had it ever been an emergency? To what extent should I restrict my involvement with him and his family, preserving my time for the patients entitled to full NHS treatment?
Insidiously, these questions corrupted the entire ward. Doctors and nurses all collaborated with an institutional diktat to limit care to the bare minimum, to varying degrees. It affected our relationships with allof our patients, first imperceptibly and then overtly.
We were no longer the advocates for their best interests. We were the lickspittles of a system that told us to approach people for their PIN codes, not their consent. They did not thank us for defending their taxes. Everyone was poorer for the experience, migrant or not.
Too high a price
These proposals go further than ever before in placing an administrative burden on Emergency departments that will be unworkable and opaque.
It will be applied haphazardly throughout the country.
It will be more expensive than what we have now.
It will appal the public.
It will corrode the professionalism and integrity of the clinical staff who look after all of us. I’ve seen that.
It’s targeting a problem that costs us 0.06% of the NHS’ annual budget.
I’d rather not, if it’s all the same to you. If the government wants to win some cheap votes on immigration, there are one or two other places to start.
*patient details changed